What is the best treatment for laryngitis?

Best Treatment for Laryngitis

The best treatment for laryngitis is symptomatic relief including voice rest, adequate hydration, and analgesics, while avoiding antibiotics and systemic corticosteroids due to lack of proven benefit and potential for harm. 1, 2

First-Line Treatment Approach

• Voice rest is essential to reduce vocal fold irritation and promote healing 1
• Adequate hydration helps maintain mucosal moisture and reduce irritation 1
• Analgesics or antipyretics, such as acetaminophen or NSAIDs, can be used for pain or fever relief 2
• Avoid speaking loudly or whispering, as both can strain the vocal cords 1

Medications to Avoid

Antibiotics

• Antibiotics should not be routinely prescribed for laryngitis 3, 2
• A Cochrane systematic review found that antibiotics do not appear to be effective in treating acute laryngitis when assessing objective outcomes 4
• Inappropriate use contributes to bacterial resistance, increases healthcare costs, and may cause side effects including laryngeal candidiasis 2

Corticosteroids

• Oral corticosteroids should not be routinely prescribed for laryngitis in adults 3, 1
• There is a preponderance of harm over benefit for steroid use 3
• Potential adverse effects include hypertension, cardiovascular disease, osteoporosis, impaired wound healing, infection risk, and mood disorders 3

Special Considerations

Duration and Evaluation

• Acute laryngitis is typically self-limited, with improvement occurring within 7-10 days even with placebo treatment 1
• Laryngitis persisting beyond 2-3 weeks warrants further evaluation, including laryngoscopy 3, 2
• Laryngoscopy is indicated if symptoms fail to improve or resolve within three months, or at any time a serious underlying disorder is suspected 3

Reflux-Related Laryngitis

• For patients with signs of reflux laryngitis on laryngoscopy (erythema, edema, redundant tissue of the vocal folds), anti-reflux treatment may be considered 3
• However, anti-reflux medications should not be used as empiric therapy for hoarseness without symptoms of GERD or laryngeal findings 3
• Be aware of potential PPI side effects, including decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 3

Pediatric Considerations

• In pediatric patients with croup and associated symptoms like hoarseness, systemic steroids have shown better outcomes 3
• The most common age of occurrence for laryngitis in children is 0.5 to 3 years 5
• Parainfluenza viruses are the most common causative agents of laryngitis in children 5

Specific Clinical Scenarios

Ulcerative Laryngitis

• Treatment may include reflux medications (85%), antibiotics (22%), antifungals (39%), antivirals (52%), steroids (52%), and/or voice rest (65%) 6
• Earlier initiation of treatment may improve voice outcomes 6
• Average time to ulcer resolution is approximately 2.25 months 6

Occupational Considerations

• Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis 7
• In limited cases of allergic laryngitis in performers, systemic steroids have been reported to provide quick relief, though these are not high-quality trials 3

Treatment Algorithm

1. Confirm diagnosis (viral laryngitis is most common)
2. Recommend voice rest and adequate hydration
3. Provide analgesics for symptomatic relief
4. Avoid antibiotics and corticosteroids
5. If symptoms persist beyond 2-3 weeks, refer for laryngoscopy
6. For reflux-related laryngitis confirmed by laryngoscopy, consider anti-reflux treatment
7. For pediatric patients with croup symptoms, consider appropriate interventions including steroids

Remember that most cases of laryngitis are viral in nature and self-limiting, with symptoms typically resolving within 7-10 days 1, 2.